Aberrant Right Subclavian Artery to Esophageal Fistula: A Rare Case and Its Management

Merlo, Álvaro Roberto Crespo; Ohana, Elad; Pascarella, Luigi; Crowner, Jason; Long, Jason

doi:10.1016/j.athoracsur.2019.12.045

Cited by 8 publications

(11 citation statements)

References 3 publications

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“…2 Their temporary use in benign conditions have good results, 5 however the time interval is still not well established, varying from 4 to 16 weeks, depending on the patient. 4 One complication may be a fistula between the esophagus and adjacent structures, which, despite its rarity, can occur even with large caliber vessels, such as the aorta, 6 subclavian artery 7 and the common carotid artery, 3 as in our case. Treatment options for cases of CEF include vascular surgery with vessel reconstruction, 8 artery ligation or endovascular treatment.…”

Section: Discussionmentioning

confidence: 63%

“…Treatment options for cases of CEF include vascular surgery with vessel reconstruction, 8 artery ligation or endovascular treatment. 7,9 Vascular open surgery was not attempted in our case, considering the acute anemia associated with smaller blood volume in children. Endovascular treatment offers several options, such as conventional and covered stents, flow diverters, and embolization with detachable coils or liquid embolic agents.…”

Section: Discussionmentioning

confidence: 93%

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Carotid-Esophageal Fistula Treated By Endovascular Approach

Fachin

Demartini

Pinto

et al. 2020

Vasc Endovascular Surg

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The carotid-esophageal fistula is a rare and serious complication of the metallic esophageal prosthesis. A high index of suspicion is required for early diagnosis and treatment, decreasing the morbidity and mortality rate of this severe complication. We report a case of a 4-year-old boy presenting severe upper gastrointestinal bleeding due to a carotid-esophageal fistula, secondary to deployment of an esophageal metallic prosthesis for treatment of a recurrent stenosis. The carotid pseudo-aneurism was successfully treated with stents and coils. Although endovascular treatment is a safe and effective option, arterial stenting in children needs further studies with long-term follow-up.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 93%

Carotid-Esophageal Fistula Treated By Endovascular Approach

Fachin

Demartini

Pinto

et al. 2020

Vasc Endovascular Surg

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“…14,15,17,19,21,22,24,27,29,31,[38][39][40][41] Fistula development from prior placement of esophageal stent was noted in 5 cases. 34,36,42,43 Other reported causes for fistula formation included placement of a salivary bypass tube and a possible consequence of gastric pull-up surgery. 1,26 Fistula formation attributable to ARSA aneurysm with resultant GI bleeding is rare.…”

Section: Discussionmentioning

confidence: 99%

Upper Gastrointestinal Bleeding From Aberrant Right Subclavian Artery-Esophageal Fistula

Peress

Tuqan

Thomas

2021

TOJ

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Background:The most common aortic arch abnormality is an aberrant right subclavian artery (ARSA). ARSA-esophageal fistula is a rare sequela that can present with a life-threatening upper gastrointestinal (GI) bleed. Case Report: We report the case of an 88-year-old male who presented with signs of upper GI bleeding. Esophagogastroduodenoscopy demonstrated extrinsic compression of the upper third of the esophagus with ulceration. Imaging studies revealed ARSA posterior to the esophagus with pseudoaneurysm formation. These findings confirmed an upper GI bleed secondary to ARSA-esophageal fistula. The patient underwent prompt embolization of the ARSA pseudoaneurysm, followed a few days later by coil embolization of the ARSA pseudoaneurysm. Despite these interventions, the patient continued to have bleeding with anemia. He and his family opted to avoid any further interventions and instead pursued comfort care. The patient was discharged to hospice and died 3 months later. Conclusion: ARSA-esophageal fistula is a rare but potentially lethal cause of upper GI bleeding. Initial signs and symptoms can be subtle, but the presence of a GI bleed requires immediate stabilization. Surgical interventions have been shown to have longerlasting success, but endovascular repair may be an option for patients who are deemed unfit for surgery but still require prompt stabilization. Regardless of the intervention, mortality rates for ARSA-esophageal fistula are high.

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“…Hybrid surgical approaches utilize open arterial access, selective angiography, and stenting with either selfexpanding or balloon-expandable covered stents such as VIABAHN (Gore, Arizona USA) or Atrium V12 (Getinge, Sweden) [7,8]. Embolization of the ARSA stump is common, following open ligation and revascularization.…”

Section: Discussionmentioning

confidence: 99%

“…Open surgical techniques include thoracotomy or median sternotomy with ligation of the proximal ARSA and carotid to subclavian bypass grafting or aortoaxillary bypass grafting [2,7,9,10].…”

Section: Discussionmentioning

confidence: 99%

An Elegant Solution to a Ruptured Right Aberrant Subclavian Artery after Oesophageal Stent Removal

Thompson

Cerutti

Peerbux

et al. 2021

Case Reports in Vascular Medicine

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Arterioenteric or arteriotracheal fistula is a known complication of an aberrant right subclavian artery (ARSA) and is often associated with prolonged nasogastric or endotracheal intubation or oesophageal stenting. Fistula formation from the ARSA can present unexpectedly with rapid exsanguination with massive haemoptysis or haematemesis, and unless promptly recognised and treated is rapidly fatal. We present a novel endovascular method for treating a fistula between the oesophagus, trachea and an ARSA in an unstable patient following oesophageal stent removal, utilising a covered iliac limb stent, eliminating the need for an open surgical approach.

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Aberrant Right Subclavian Artery to Esophageal Fistula: A Rare Case and Its Management

Cited by 8 publications

References 3 publications

Carotid-Esophageal Fistula Treated By Endovascular Approach

Carotid-Esophageal Fistula Treated By Endovascular Approach

Upper Gastrointestinal Bleeding From Aberrant Right Subclavian Artery-Esophageal Fistula

An Elegant Solution to a Ruptured Right Aberrant Subclavian Artery after Oesophageal Stent Removal

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